1. How do I get a free at-home over-the-counter COVID-19 test?

Starting January 15, most people with a health plan can go online, or to a pharmacy or store to purchase an at-home over-the-counter COVID-19 diagnostic test authorized by the U.S. Food and Drug Administration (FDA) at no cost, either through reimbursement or free of charge through their insurance. This applies whether you purchased your health plan on your own or whether you get health insurance through your job.

The test will either be free directly at the point of sale, if your health plan provides for direct coverage, or by reimbursement if you are charged for your test. Be sure to keep your receipt if you need to submit a claim to your insurance company for reimbursement. If your plan has set up a network of preferred providers at which you can obtain a test with no out-of-pocket expense, you can still obtain tests from other retailers outside that network. Insurance companies are required to reimburse you at a rate of up to $12 per individual test (or the cost of the test, if less than $12). 

2. Will I have to pay for my test upfront?

The Biden-Harris Administration is strongly incentivizing health plans and insurers to set up a network of convenient locations across the country such as pharmacies or retailers where people with private health coverage will be able to order online or walk in and pick up at-home over-the-counter COVID-19 tests for free, rather than going through the process of having to submit claims for reimbursement.  Consumers can find out from their plan or insurer if it provides direct coverage of over-the-counter COVID-19 tests through such a program or whether they will need to submit a claim for reimbursement. If you are charged for your test after January 15, keep your receipt and submit a claim to your insurance company for reimbursement.   

3. How much will I be reimbursed for an at-home over-the-counter COVID-19 test if I purchase the test upfront and then submit a claim for reimbursement to my insurance company?

If you purchase an over-the-counter COVID-19 test from a pharmacy, store, or online retailer and are charged for your test, keep your receipt and submit a claim to your insurance company for reimbursement. If your plan has not set up a network of preferred stores, pharmacies, and online retailers at which you can obtain a test with no out-of-pocket expense, you will be reimbursed the amount of the cost of the test. For example, if you buy a two-pack of tests for $34, the plan or insurer would reimburse $34. 

If your plan has set up a network of preferred stores, pharmacies, and online retailers at which you can obtain a test with no out-of-pocket expense, you can still obtain tests from other retailers if you buy them outside of that network. Your plan is required to reimburse you at a rate of up to $12 per individual test (or the cost of the test, if less than $12).  Save your receipt(s) to submit to your plan for reimbursement at a rate of at least $12 per individual test (or the cost of the test, if less than $12).

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With COVID-19 deaths continuing to rise, more Americans ask themselves whether they should buy life insurance to protect their families in case of death. In fact, according to LIMRA’s 2021 Barometer Study, one in three Americans said they are more likely to buy life insurance because of the pandemic. However, whether their policy would cover a COVID-19 related death depends on several factors.

Life insurance agents are key in helping clients understand whether their beneficiaries will receive the death benefit. There are specific circumstances or certain policies where insurance companies may deny the claim if the policy owner died of COVID-19. Applicants should be made aware of these so that they can make the choice that suits the needs of their families.

Several Exceptions For Standard Life Policies

If the policyholder has a regular life insurance policy that is active, the insurer will pay the beneficiary if the insured died of complications related to COVID-19. There are a few exceptions, however.

First, if the policy is less than two years old and the applicant misrepresented material information on the application, the claim will be denied regardless of the cause of death. Second, if the insured contracted COVID-19 and was too ill to pay his life insurance premiums, allowing the policy to lapse, the claim may be denied (depending on what state the insured lived in). Third, if an employee who is covered under a group life insurance plan contracts COVID-19, becomes too ill to return to work and gets terminated without converting his group coverage into a private policy, his beneficiary’s claim may be denied.

Accidental Death Policies Do Not Cover COVID-19 Deaths

Accidental death policies usually cover deaths related to an unforeseen, sudden accident such as a car crash or drowning. They usually do not cover COVID-19-related deaths as they are considered to be due to natural causes. If the insured died in an accident while he had COVID-19, the claim will be paid provided none of the exclusions apply and COVID-19 did not contribute to the accident.

COVID-19 Is Not Listed As A Critical Illness

Similarly, many critical illness policies deny coverage for COVID-19 as such policies may not list COVID-19 as a covered illness. Critical illness policies list illnesses for which coverage would be available. If COVID-19 is not listed in a critical illness policy, the claim is likely to be denied.

If a person suffers from a covered illness and contracts COVID-19, however, the claim should be paid.

Another exception is for cases when COVID-19 leads to covered conditions, such as organ failure. It is a good practice for applicants looking to buy a critical illness policy to read the contract and discuss it with their advisor to better understand what illnesses it would cover.

Accelerated Death Rider May Require Physician Certification

Accelerated death policies pay a certain amount of death benefit to the insured who is alive but terminally ill and has a short life expectancy. Every accelerated death policy has a list of requirements that need to be met in order for the claim to be payable.

For example, many require that a treating physician sign a life expectancy letter certifying that the insured is terminally ill and has a life expectancy of 12 months or less. Unless all the requirements under the contract are met, the claim will be denied. Thus, if the insured has COVID-19 and is very ill, unless they have a letter from his physician confirming his short life expectancy, their claim for accelerated death benefit will most likely be denied.

One step in securing a policy that fits the applicant’s family’s financial needs is to work closely with a life insurance agent to understand the type of coverage they are purchasing. Life insurance agents should discuss all possible scenarios involving COVID-19-related deaths. At the same time, it is in the applicant’s best interest to read the policy and analyze possible scenarios when life insurance will not pay.

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healthinsurance.org contributor

March 22, 2016

If your current health insurance policy is not but was in effect prior to 2014, your plan is considered a transitional, or “grandmothered” policy. These plans are not fully , and were purchased between March 23, 2010 – when the ACA was signed into law – and October 1, 2013 (in some states, policies purchased through December 31, 2013 are considered grandmothered).

They are different from grandfathered plans, which are policies that were already in force on March 23, 2010. Grandfathered policies are allowed to remain in force indefinitely, without having to become fully compliant with the ACA, as long as they don’t make changes that would substantially cut benefits or increase costs for insureds. Although most of the ACA’s regulations do not apply to grandfathered plans, they do have to of the healthcare reform law.  

What grandmothered plans must cover

Grandmothered plans must to comply with more ACA regulations than grandfathered plans. These include covering preventive care with no cost-sharing, and eliminating annual benefit limits for any (EHBs) that the plan covers (grandmothered plans are not required to cover EHBs other than preventive care, but if they do provide coverage, they cannot place an annual dollar limit on it).

Individual grandmothered plans must also with mental health parity rules starting with plan years that began on or after July 1, 2014. In addition, in the small group market, grandmothered plans cannot have pre-existing condition exclusions, or benefit waiting periods that exceed 90 days. But in both the individual and small group market, grandmothered plans are exempt from some of the main consumer protections and mandates in the ACA, most of which went into effect on January 1, 2014.

How grandmothered plans came about

There was nearly a four year gap between the passage of the ACA and the bulk of the implementation at the start of 2014. During that time, hundreds of thousands of new individual and small group policies were sold. Originally, the plan was that all existing, non-grandfathered policies (ie, the ones that had become effective after March 23, 2010) would have to be swapped for ACA-compliant coverage as January 1, 2014, or in some states, as of their 2014 renewal date.

Then in the fall of 2013, the Obama Administration a transitional relief program that would let states and carriers allow these individual and small group policies to early renew at the end of 2013 (regardless of when the plans’ original renewal date would have been) and remain in force until their new renewal date in late 2014. This provision had already been adopted by some states prior to the federal announcement, but the HHS announcement caused many states to reexamine the issue.  

This was seen by some as an unfortunate loophole, and a few states had already taken steps in the summer of 2013 to early renewal. But many states and carriers accepted the new guidelines.

2 more extensions; final expiration date = December 2017

In March 2014, HHS the transitional relief, permitting renewals as late as October 1, 2016, with the plans allowed to remain in force until as late as September 30, 2017. Grandmothered plans that were renewed in late 2013 and scheduled to expire in late 2014 (under the terms of the initial transitional relief) were eligible to be renewed instead, if the state and the insurance carrier allowed it. In many states, those plans were once again eligible for renewal in late 2015, and are still in force.

Then another , allowing grandmothered plans to continue to renew up until October 1, 2017, but with a termination date no later than December 31, 2017 (carriers can use plan years of less than 12 months, or early renewal as of January 1, 2017 in order to make this work). As was the case with previous extensions, this one is also subject to the discretion of states and health insurance carriers.

The new extension helps to align the termination date of grandmothered plans with the open enrollment period for 2018 coverage. So instead of having grandmothered plans terminate at their first renewal date after October 1, 2016, grandmothered plans will be eligible for renewal again throughout most of 2017 (up until October 1, 2017). But they must terminate by the end of 2017, regardless of their renewal date.

The provision allowing grandmothered plans to renew up until October 1, 2017 (instead of October 1, 2016) will be particularly helpful for people with grandmothered plans that have renewal dates between October 2 and December 31, and who wish to keep their coverage in 2017. Without the extension that HHS issued in February 2016, all of those plans would have had to terminate in late 2016, as their renewal date would have been after October 1, 2016. With the new extension – assuming states and carriers agree to allow it – those plans will instead be eligible for renewal in late 2016, and will be able to remain in force in 2017.

But by the end of 2017, all non-grandfathered health plans that are not yet fully compliant with the ACA will have to be replaced with ACA-compliant coverage, purchased either on or .

It’s important to note that even in states where these plans are still eligible for renewal, they cannot be sold to new customers – all new policies must be fully ACA-compliant.

States allowing renewals of grandmother plans

The transitional relief program leaves the final decisions up to states and carriers. Each state had to decide whether it would allow grandmothered policies to renew again after January 1, 2014, and whether they will allow those renewals to continue as late as October 2017 (with coverage allowed to remain in force through the end of 2017). If a state agrees to allow transitional plans to continue to renew, the final decision is left to the carriers to determine whether to offer those policies for renewal.

35 states have allowed grandmothered plans to remain in force in 2016 and renew one last time as late as October 1, 2016. But many of these states have not yet said whether they’ll go along with the final extension issued by HHS that would allow grandmothered plans to renew as late as October 2017, as long as they terminate by the end of December 2017. This page will be updated periodically to reflect state Insurance Commissioners’ decisions on the final extension.

Grandmothered plans still exist in 2016 in the following states:

• (plans can remain in force until December 2017. However, Blue Cross Blue Shield, which had in Alabama in 2013, decided non-compliant plans into 2014)
• (plans can remain in force through December 2017)
• (plans can remain in force through December 2017)
• (plans can remain in force through December 2017)
• (plans can remain in force through December 2017)
• (plans can remain in force through December 2017; the state did not issue any official guidance on the extension through December 2017, but communicated the information directly to the health insurance carriers)
• (plans can remain in force through December 2017. All grandmothered plan renewals on or after August 1, 2016 will have policy periods that extend through December 2017, with a consistent premium. So a plan that renews on August 1, 2016 will be renewed for a period of 17 months, with no rate changes during that time. Idaho has also addressed how accumulation periods for out-of-pocket costs will work on renewed grandmothered plans)
• (plans can remain in force through December 2017. Health plans cannot impose additional cost-sharing or premium increases in the final months of 2017; the renewal rates and out-of-pocket amounts that apply to the final renewal must be extended through the end of 2017 if the plan remains in force through the end of 2017)
• (plans can remain in force through December 2017)
• (plans can remain in force through December 2017)
• Kansas (plans can remain in force through December 2017. The Kansas Insurance Department confirmed by phone that they are going along with the most recent guidance from CMS)
• (plans can remain in force through December 2017, per an email confirmation that was sent to carriers; some carriers had previously that they would not allow grandmothered plans to extend beyond their 2014 renewal date).
• (plans can remain in force through December 2017)
• (Anthem is the only individual market carrier in Maine carrier with grandmothered plans, and has filed a request to as of January 2017).
• (plans can remain in force through December 2017)
• Mississippi (plans can remain in force through December 2017; the Mississippi Insurance Department confirmed that the state is going along with the CMS guidance).
• (as of late May, 2016, the Missouri Department of Insurance had not yet issued further guidance on transitional plans)
• (plans can remain in force through December 2017)
• (plans can remain in force through December 2017, but only if they’re renewed on or before January 1, 2017; no transitional plan renewals will be allowed after January 1, 2017 – plans will have to terminate and be replaced with ACA-compliant coverage as of their first renewal after January 1, 2017).
• (plans can remain in force through December 2017)
• (plans can remain in force through December 2017)
• (plans can remain in force through December 2017; no additional bulletins were issued, but the ND Insurance Department confirmed that the state will follow the latest guidance from CMS).
• (plans can remain in force through December 2017)
• (plans can remain in force through December 2017)
• (plans can remain in force through December 2017; opted to go along with the initial transitional relief, seven in the individual market, and six in the small group market).
• (plans can remain in force through December 2017)
• Tennessee (Department of Commerce and Insurance confirmed that plans can remain in force through December 2017. However BCBS, which insured of the individual market in 2013, only renewed grandmothered plans ).
• According to the Texas Department of Insurance, “there is nothing in Texas law prohibiting a carrier from renewing policies that are compliant with Texas requirements.” The state has not put out any official guidance on the latest extension rules from CMS, but they confirmed that carriers are free to follow the CMS guidance if they wish.
• (plans can remain in force through December 2017; Utah code 31A-30-117(3) allows non-grandfathered health plans to remain in force “to the extent permitted by the Centers for Medicare and Medicaid Services, so the extension issued by CMS in February 2016 is applicable in Utah).
• (plans can remain in force through December 2017. Legislation was passed in November 2014 that allowed for the renewal of non-ACA-compliant plans, but as it was very late in the year by that point, most carriers did not reverse course and allow those plans to renew for 2015., although the Bureau of Insurance noted that they were the only individual carrier to do so, and their enrollment is small; the Bureau of Insurance did say that some small group carriers may have extended transitional plans in the state, but they don’t track that).
• (the WV Office of the Insurance Commissioner confirmed by phone that West Virginia is allowing small group transitional plans to remain in force until as late as December 31, 2017, but only if they’re renewed by January 2017. Renewals will not be permitted after January 2017. There are no longer any transitional individual market plans in West Virginia, as carriers have terminated those plans and replaced them with ACA-compliant plans instead. The state also filed against HHS over the extension of transitional plans in 2014).
• (plans can remain in force through December 2017)
• Wyoming (Plans can remain in force through December 2017; Wyoming did not issue a written statement either way, which means they defaulted to the final extension issued by CMS).

States not permitting renewals of grandmothered plans

Fifteen states and the District of Columbia have not extended renewals of non-ACA-compliant plans. In most cases, this was effective as of 2014, although Oregon and Colorado allowed grandmothered plans to remain in force through the end of 2015).

• (grandmothered small group plans were allowed to remain in force ).
• (The state allowed renewal through 2015, but not into 2016.)
• (CT’s insurance commissioner confirmed the state made no changes after the March 2014 announcement from HHS.)
• District of Columbia
• (Non-grandfathered plans were required to be updated in order to become compliant with the ACA as of January 1, 2014. Carriers in Minnesota were not permitted to cancel coverage unless they left the market entirely.)
• Montana (state regulators didn’t prohibit renewal of grandmothered plans, although they did encourage carriers to switch to ACA-compliant plans instead of renewing grandmothered plans.  Ultimately, all individual market carriers decided to switch to ACA-compliant plans, so there are no grandmothered plans in Montana)
• (plans cannot be renewed after the end of 2014, but may continue to exist until their 2015 renewal date.  At that point, they must be replaced with an ACA-compliant plan)
• New York
• (Grandmothered plans can only remain in force through December 31, 2015.)
• (The state allowed 2013 plans to be extended only briefly, until March 31, 2014.)

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Can Democrats scare Republicans into giving up their plans to repeal ObamaCare? They’re certainly trying: President Obama recently warned that if Congress junks the Affordable Care Act, “133 million Americans with pre-existing conditions” will be in jeopardy. That’s a phony figure, for several reasons. The actual number is roughly 500,000.

For starters, half of Americans get their insurance through an employer, the Kaiser Family Foundation. Another 34% are on Medicaid or Medicare. For all these people, pre-existing conditions are no barrier to coverage.

Pre-existing conditions mattered before ObamaCare only in the individual market, but even there few were affected. In 2010 Rep. Henry Waxman, then the Democratic chairman of the House Energy and Commerce Committee, on the individual market. It stated that the four largest insurers—, , and WellPoint—declined to issue policies to about 250,000 people a year because of their medical histories. A 2011 report from the Government Accountability Office found a similar number.

The Waxman memo also explains that insurers also sometimes issued policies with “riders” to exclude certain coverage. The four big insurers refused to pay about 70,000 claims a year because of pre-existing conditions.

Even so, many people with pre-existing conditions managed to get health coverage through the high-risk pools run by 35 states. Those pools covered about 225,000 people in 2011, the Kaiser Family Foundation.

But some states did not operate high-risk pools. Others, including California and Florida, had patients on waiting lists or capped enrollment. So in 2010 the Obama administration opened a temporary nationwide high-risk pool to serve that unmet need. Enrollment peaked at 115,000 in March 2013, Kaiser .

Adding together these figures indicates that around 500,000 people with pre-existing conditions would need protection once ObamaCare is repealed. That’s a minuscule fraction of Mr. Obama’s 133 million. The president’s number is from produced by his own Department of Health and Human Services, which vastly exaggerates the health problems serious enough to result in a coverage denial. For example, the report counts 46 million people with high blood pressure. Even more deceptively, the report includes people covered by employer plans or Medicaid.

Not even ObamaCare architect Jonathan Gruber says that the ban on pre-existing conditions expanded the ranks of the insured. for the New England Journal of Medicine, co-written by Mr. Gruber, attributes 63% of the gains in coverage under ObamaCare to the expansion of Medicaid and 37% to the subsidies for buyers with low incomes. The individual mandate, the paper states, had “no significant effect.” Pre-existing conditions aren’t even mentioned.

Republican plans to repeal and replace ObamaCare include re-establishing federally funded high-risk pools, with a guarantee of no waiting lists. That’s likely to cost $16 billion to $20 billion annually—or about $32,000 per person, which was the average patient cost in the federal high-risk pool in 2012. Sixteen billion dollars is far more than what Republicans are currently budgeting, but far less than the $56 billion that will be spent on ObamaCare subsidies this year, the Congressional Budget Office.

Patients with serious illnesses probably would be better off with coverage through high-risk pools than under the status quo. ObamaCare plans offer narrow networks that exclude many top-drawer hospitals and specialists like oncologists.

High-risk pools would also subdue premium increases for healthy buyers by removing the largest costs from the insurance pool. The sickest 5% of Americans account for 50% of health-care spending, Kaiser. The healthy can see that paying the same price for insurance as the sick is a bad deal. That’s why ObamaCare enrollment skewed older and sicker than expected, causing insurers to lose $2 billion a year. UnitedHealth, Aetna and others have fled the market or dramatically raised premiums. Funding high-risk pools for the sickest Americans—and doing it soon, as part of this month’s budget reconciliation—could avert a market collapse.

That’s what Alaska did last June. State officials acted on their own to stave off a 40% increase in ObamaCare premiums by paying for the sickest people with $55 million in taxpayer funds. It worked, keeping premium growth to single digits. Congress can do the same for the entire nation. It will mean improved coverage for people with serious illnesses and a fair deal for the healthy.

That beats scaring the nation with phony numbers and fake news about pre-existing conditions.

—Ms. McCaughey, a senior fellow at the London Center for Policy Research, served as lieutenant governor of New York

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It appears more and more likely that the Affordable Care Act (ACA) could be repealed or revised by the Republican-controlled 115th Congress. Recent announcements from President Trump and House Speaker Paul Ryan claim progress on plans to repeal and replace the ACA. “We’re doing Obamacare, we’re in the final stages,” Trump told a news conference. “So we will be submitting sometime in early March, mid-March.” On February 16, Ryan told reporters that House Republicans would introduce legislation to repeal and replace the ACA after the House returns from the President’s Day break on February 27. Repeal of the ACA is also supported by newly-installed U.S. Health and Human Services (HHS) Secretary Tom Price who told Republican lawmakers that on repeal of ACA, “The president is all in on this.”

Republicans, who control the White House and Congress, have long vowed to repeal the ACA, but have had difficulty agreeing on a detailed plan to do so. A recently released policy brief, , provides some suggested plans for how Republicans hope to get this done. The plan suggests that the ACA penalty taxes for the individual mandate and the employer mandate should be repealed immediately. And to provide relief during a transition period, Americans eligible for the current ACA subsidy should be able to use an advanceable and refundable tax credit to assist with the purchase of health insurance on the individual insurance market. If an employer does not subsidize COBRA coverage, an individual might also use the credit to help pay unsubsidized COBRA premiums while between jobs. And if the individual does not use the full value of the credit, he or she could deposit the excess amount into a health savings account (HSA). The policy paper also suggests an expansion of the number of individuals who can use HSAs, and an expansion of how individuals and their families can use HSAs.

What remains clear is that the Republicans’ plans for healthcare are still very much a work in progress. And in the meantime, the individual and employer mandate and penalty provisions are still in place and are currently being enforced. The IRS has announced on its webpage that it won’t reject a taxpayer’s 2016 personal income tax return if the taxpayer doesn’t answer the health coverage question. The IRS, however, is still reserving the right to follow up with the taxpayer, at a future date, regarding compliance with the individual mandate, if the person ‘s tax return doesn’t provide the health coverage information. The announcement also confirms that employers are still required to file their ACA reporting forms and those forms will be rejected if they don’t contain the requisite information. The IRS extended the due date for providing 2016 health coverage information forms to individuals. Insurers, self-insuring employers, other coverage providers, and applicable large employers have until March 2, 2017 to provide Forms 1095-B or 1095-C to individuals, which is a 30-day extension from the original due date of January 31. The due dates for filing 2016 information returns with the IRS remain unchanged for 2017. The 2017 due dates are February 28 for paper filers and March 31 for electronic filers.

Legislative provisions of the ACA law are still in force until changed by Congress. In the meantime, while Congress considers options to repeal and replace the ACA, taxpayers and employers should be prepared to continue to comply with the law through at least 2018. We will continue to watch decisions over the coming weeks, and provide details on new and revised employer obligations as they take shape over time.

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Notable Provisions of the American Health Care Act

If signed into law, the American Health Care Act would, among other changes, make the following revisions to key features of the ACA over the next three years:

• “Pay or Play”: Penalties for noncompliance with the “pay or play” coverage requirement (which mandates, in general, that employers with 50 or more full-time employees [including full-time equivalent employees] must offer affordable, minimum value coverage to their full-time employees, or pay a penalty tax) are zeroed out. However, the Form 1094 & 1095 reporting requirements are unchanged by the bill. 
• Individual Mandate: Penalties for noncompliance with the individual mandate are zeroed out, effectively repealing the mandate. In its place, the bill requires issuers in the individual or small group markets to impose a 30% penalty on the health insurance premiums of individuals who do not maintain continuous health insurance coverage.
• HSA Contribution Limits: Limits on contributions to health savings accounts (HSAs) are increasedto equal the inflation-adjusted annual out-of-pocket expenses limitation imposed on high deductible health plans (currently $6,550 (self-only coverage)/$13,100 (family coverage)).
• Health FSA Contribution Limits: Limits on contributions to health flexible spending arrangements (health FSAs) are eliminated.
• Tax Credits for Individual Coverage: Replaces the ACA’s premium tax credits for individual market coverage with advanceable, refundable tax credits adjusted for both age and income. 
• Market Reforms: Permits states to seek waivers from the ACA’s essential health benefits and age and health status community rating requirements.
• Medicaid: Allows states to elect to receive federal Medicaid funding via a block grant or per capita allotment, and alters the ACA’s Medicaid expansion.

to read the American Health Care Act in its entirety.

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Effective for plan years ending on or after October 1, 2012, and before October 1, 2019, employers that sponsor certain self-insured health plans are responsible for Patient-Centered Outcomes Research Institute (PCORI) fees. Fees for plan years that ended in 2016 are due July 31, 2017.

How to Pay PCORI Fees:

Employers that sponsor must report and pay the required PCORI fees via IRS Form 720, Quarterly Federal Excise Tax Return. For plan years ending between January 1, 2016 and September 30, 2016, the fee for an employer sponsoring an applicable self-insured plan is $2.17 multiplied by the average number of lives covered under the plan. For plan years ending between October 1, 2016 and December 31, 2016, the fee is $2.26 multiplied by the average number of lives covered under the plan.

For additional information, visit our section on .

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Senate to Vote on ACA Repeal and Replace Bill

In another effort to repeal and replace the Affordable Care Act (ACA), the Senate is expected to vote later next week on the Graham-Cassidy-Heller-Johnson (GCHJ) bill, which would replace many of the ACA’s provisions with block grants given annually to States to help individuals pay for healthcare. Democratic Senators continue to be united in their opposition to repealing the ACA and the timeframe for passing the bill without any bipartisan support is extremely limited. Republicans will use the reconciliation process (which expires September 30th) to attempt to move the bill through the Senate on a simple majority. A Congressional Budget Office score of the bill is expected soon.

• The bill would eliminate the employer and individual mandate penalties, but like prior repeal and replace measures, the ACA’s employer reporting requirements would remain since they are not expressly repealed in the bill. The bill also does not include an alternative incentive for people to obtain coverage, which raises concerns for further destabilization of the individual health insurance market.
• Under the bill, States would be offered the ability to waive federal law requiring limitations on rating in individual and small group market, health status underwriting, coverage of specific benefits, and medical loss ratio requirements. In turn, the federal government would provide funding through a block grant program that allows States to devise their own health insurance rules and standards. The waiver of laws is not specific to ACA Section 1332, so it is not clear that a State could seek a waiver that would effectively permit it to impose an employer shared responsibility tax on employers in the State.
• The bill repeals the ACA tax on medical devices, but does not repeal or further delay the 40 percent “Cadillac Tax” and it does not repeal or further delay the health insurer tax. The bill also repeals the ACA provision that eliminates the deduction for expenses allocable to a Medicare Part D subsidy – effective for taxable years beginning after December 31, 2016.
• The bill includes greater flexibility for both Flexible Savings Accounts (FSAs) and Health Savings Accounts (HSAs), and repeals the tax on over-the-counter medications.
• The bill specifically repeals cost-sharing reductions established by the ACA as of December 31, 2019.
• The bill provides for per capita Medicaid funding, 6-month eligibility redetermination and state-based work requirements. The federal money currently provided to States for Medicaid would be replaced by block grants. A significant reduction in Medicaid coverage is likely to increase the overall number of uninsured individuals, which could ultimately result in cost-shifting to employer payers.

It remains unclear whether Republicans can get the needed votes on the bill. If the Senate does manage to pass the bill, it will still also need approval from the House and the President’s signature before it can become law.

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Key Highlights

The following are key highlights of the order:

• Association Health Plans (AHPs): The executive order directs the DOL to consider adopting a broader interpretation of the Employee Retirement Income Security Act (ERISA), which could potentially allow employers in the same line of business anywhere in the country to join together to offer health insurance coverage to their employees.
• Short-Term, Limited Duration Insurance (STLDI): The executive order directs federal agencies to consider ways of expanding coverage through low-cost STLDI, which is not subject to certain ACA rules.
• Health Reimbursement Arrangements (HRAs): The executive order directs federal agencies to consider changes to the rules regulating HRAs so that employers can make better use of these arrangements for their employees.

For more information on this executive order, .

Note: In general, executive orders must be implemented in a manner consistent with applicable law, including the Administrative Procedure Act, which requires extended review of and public comment on any federal rules which may be proposed as a result of an executive order. Going forward, we will promptly report changes made to any ACA requirements.

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